Children Quiz

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Adult and child

Adult

Question 1

How does your asthma make you feel today?

I feel very ill today.

I feel ill today.

I feel well today.

I feel very well today.

Question 2

How much does your asthma bother you when you run, exercise or play sports?

It bothers me a lot; I can't do what I want to do.

It bothers me and I don't like it.

It bothers me a bit but it's okay.

It doesn’t bother me.

Question 3

Do you cough because of your asthma?

Yes, always.

Yes, most of the time.

Yes, some of the time.

No, never.

Question 4

Do you wake up during the night because of your asthma?

Yes, always.

Yes, most of the time.

Yes, some of the time.

No, never.

Question 5

During the past 4 weeks, how many days did your child have any daytime asthma symptoms?

Not at all 1-3 days 4-10 days 11-18 days 19-24 days Every day

Question 6

During the past 4 weeks, how many days did your child wheeze during the day because of asthma?

Not at all 1-3 days 4-10 days 11-18 days 19-24 days Every day

Question 7

During the past 4 weeks, how many days did your child wake up during the night because of asthma?

Not at all 1-3 days 4-10 days 11-18 days 19-24 days Every day

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PART 2

Adult

Please complete the following questions on your own.

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DATE OF PREPARATION: JANUARY 2020

DOCUMENT NUMBER: NP-GBL-ASU-WCNT-190001

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